FORM Q1                                                                     RETURN WITH PAYMENT 
                                             INDIVIDUAL QUARTERLY ESTIMATE 20__ 
     MAKE CHECK OR MONEY ORDER TO:                                                                            AMOUNT 
                    CITY OF READING                                              CITY OF READING 
                                             MAIL                                EARNINGS TAX ACCOUNT         ENCLOSED $....................... 
          PAID CHECK WILL BE YOUR RECEIPT    TO:                                 LOCATION 0863                Check No: 
                                                                                 CINCINNATI  OH  45264-0863 
          DO NOT REMIT CASH BY MAIL                                                                            _____ Quarter 20__ 
                                                     Phone 513-733-0300   Fax 513-842-1016 
          ESTIMATED TAX        TOTAL UNDER PAID                                    TOTAL AMOUNT               AMOUNT OF         QUARTERLY 
                   DECLARED    ESTIMATE PENALTY                                    CREDITED                   UNPAID BALANCE    INSTALLMENT DUE 
                                                                                                                              
   NAME                                                                                                        DUE ON OR BEFORE                          
 
    AND 
 
   ADDRESS 
                                                                                                               TAX ID                            
                                                                                 
                            NOTIFY INCOME TAX DEPARTMENT OF ANY CHANGE IN EMPLOYMENT, OWNERSHIP AND ADDRESS SHOW ABOVE 
                            IF THIS STATEMENT DOES NOT REFLECT PAYMENT RECENTLY MADE, PLEASE ADVISE INCOME TAX OFFICE PROMPTLY 
                                                                                    
FORM Q1                                                                    KEEP FOR YOUR RECORDS 
                                                 INDIVIDUAL QUARTERLY ESTIMATE 20__ 
     MAKE CHECK OR MONEY ORDER TO:                                                                            AMOUNT 
                    CITY OF READING                                              CITY OF READING 
                                             MAIL                                EARNINGS TAX ACCOUNT         ENCLOSED $....................... 
          PAID CHECK WILL BE YOUR RECEIPT    TO:                                 LOCATION 0863                Check No: 
                                                                                 CINCINNATI  OH  45264-0863 
          DO NOT REMIT CASH BY MAIL                                                                            _____ Quarter 20__ 
                                                     Phone 513-733-0300   Fax 513-842-1016 
          ESTIMATED TAX        TOTAL UNDER PAID                                    TOTAL AMOUNT               AMOUNT OF         QUARTERLY 
                   DECLARED    ESTIMATE PENALTY                                    CREDITED                   UNPAID BALANCE    INSTALLMENT DUE 
                                                                                                                              
   NAME                                                                                                        DUE ON OR BEFORE                          
 
    AND 
 
   ADDRESS 
                                                                                                               TAX ID                            
                                                                                 
                            NOTIFY INCOME TAX DEPARTMENT OF ANY CHANGE IN EMPLOYMENT, OWNERSHIP AND ADDRESS SHOW ABOVE 
                            IF THIS STATEMENT DOES NOT REFLECT PAYMENT RECENTLY MADE, PLEASE ADVISE INCOME TAX OFFICE PROMPTLY 
                                                                                    
                                                 CREDIT CARD AUTHORIZATION: 

□ VISA              □ MASTERCARD 
Print Name:         ________________________________________ 
 
Signature:          ________________________________________ 
 
Account Number 

□□□□ □□□□ □□□□ □□□□                                                                  
Expiration Date: ______ / ______                     CVC______ 3 digit security code on back of card